WEB HOSTING ORDER FORM

Thank you for choosing ZyLink for your hosting needs. Please fill out the form below to order your web site. (Credit card payment by secure connection is available. Instructions will be provided upon completion of this form.) If you have questions, please feel free to e-mail us, or call us at 1-818-509-8579.

DEDICATED SERVER
Lantech SPECIAL (IDE)	Linux $99 per month Windows 2003 $115 per month
Control Panel	None Plesk $35/month CPanel $30/month Ensim $35/month
Your First Name:
Your Last Name:
Company Name:
Address:
City:
State or Province: (Use 2 letter abbrev.)
Postal Code:
Country:
Phone number (include area code):
e-mail:
Main domain name to be associated with this server:	WWW.
Is this domain	New Already existing
If already existing, is there a current web site?	Yes No
List any additional domains you want to register
Choose a password (5-10 char)
Confirm password
How did you hear about us?:
Special Instructions or requests (use this space to enter any offer codes)
Which method do you plan to use for payment?:	Check or Money Order Credit Card (Visa, Mastercard, Discover, American Express or JCB) Wire Transfer ($100 minimum order)

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